TRICARE; Reserve and Guard family member benefits. Final rule.
This final rule implements sections 704 and 705 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005. These provisions apply to eligible family members who become eligible for TRICARE as a result of their Reserve Component (RC) sponsor (including those with delayed effective date orders up to 90 days) being called or ordered to active duty for more than 30 days in support of a federal/contingency operation and choose to participate in TRICARE Standard or Extra, rather than enroll in TRICARE Prime. The first provision gives the Secretary the authority to waive the annual TRICARE Standard (or Extra) deductible, which is set by law (10 U.S.C. 1079(b)) at $150 per individual and $300 per family ($50/$100 for families of members in pay grades E-4 and below). The second provision gives the Secretary the authority to increase TRICARE payments up to 115 percent of the TRICARE maximum allowable charge, less the applicable patient cost share if not previously waived under the first provision, for covered inpatient and outpatient health services received from a provider that does not participate (accept assignment) with TRICARE. These provisions help ensure timely access to health care and maintain clinically appropriate continuity of health care to family members of Reservists and Guardsmen activated in support of a federal/contingency operation; limit the out-of-pocket health care expenses for those family members; and remove potential barriers to health care access by Guard and Reserve families.
D017047:Cost Sharing; D004608:Eligibility Determination / Q000191:economics* / Q000331:legislation & jurisprudence; D005190:Family; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence; D008889:Military Personnel / Q000331:legislation & jurisprudence*; D014481:United States